Active NPI
Rebecca Renelus, DDS
- Pediatric Dentistry
- Rohnert Park, CA
National Provider Identifier
1255004933
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 108919
- Practice address
- 5900 State Farm Dr
Rohnert Park, CA 94928-2149 - Phone
- (707) 559-7500
- NPI assigned
- Jul 28, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DN25540 | FL | |
| Pediatric Dentistry | 1223P0221X | 108919 | CA | Primary |
Addresses
Primary practice location
5900 State Farm Dr
Rohnert Park, CA 94928-2149
Mailing address
2012 Avenue D SW
Winter Haven, FL 33880-2544
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN25540 | FL | MD | Dentist |
| 108919 | CA | MD | Anatomic Pathology & Clinical Pathology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1627430400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1689033600000",
"number": "1255004933",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2012 AVENUE D SW",
"city": "WINTER HAVEN",
"state": "FL",
"postal_code": "338802544"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5900 STATE FARM DR",
"city": "ROHNERT PARK",
"state": "CA",
"postal_code": "949282149",
"telephone_number": "707-559-7500"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RENELUS",
"first_name": "REBECCA",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-07-28",
"last_updated": "2023-07-11",
"certification_date": "2023-07-11",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "FL",
"license": "DN25540",
"primary": false
},
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "CA",
"license": "108919",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rohnert Park, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.